Question

A.K., a 68-yr-old married Asian American woman, has been diagnosed with breast cancer. She is scheduled...

A.K., a 68-yr-old married Asian American woman, has been diagnosed with breast cancer. She is scheduled for surgery in the morning for a lumpectomy and sentinel lymph node biopsy with possible axillary node dissection.

  • When she is seen in the preoperative clinic 1 week before surgery, she is crying uncontrollably and says, “My husband does not want to look at me anymore. He is afraid of what I am going to look like with a flat chest.”
  • She says, “I cannot sleep and I just pace the floor at night.”
  • “My mother died of breast cancer when she was 60, and my sister got it when she was 40.”
  • Expresses concern that her two daughters (34 and 32) and their daughters are going to get “this horrible disease.”

Operative Procedure-

  • A lumpectomy and sentinel lymph node biopsy are performed.
  • A.K. has cancer cells in her sentinel lymph node.
  • Axillary node dissection is then done, involving the removal of 12 nodes.

Postoperative

  • Does not want to leave hospital. She wants to stay in bed.
  • Swelling and restricted range of motion in right arm.
  • Pain not controlled well with pain medication.

Follow-Up Findings and Treatment

  • Two positive lymph nodes are found.
  • Scheduled for outpatient chemotherapy followed by external radiation.

Discussion Questions

  1. What in A.K.'s breast cancer experience with her family members may influence her coping response?
  2. Patient-Centered Care: What information would you provide to A.K. about her surgery?
  3. What complication did she develop after her surgery?
  4. Which common postoperative exercises will A.K. need to practice after her surgery?
  5. Teamwork and Collaboration: Which of the following personnel should provide this instruction to A.K.: registered nurse, licensed practical/vocational nurse, unlicensed assistive personnel?
  6. What community resources are available to help A.K. and her family adjust to the change in her body and to cope with the diagnosis of cancer? How can you access these resources?
  7. What information is important for you to provide to A.K. about her radiation treatment and chemotherapy?
  8. Priority Decision: Based on the assessment data, what are the priority nursing diagnoses? Are there any collaborative problems?
  9. What information is important for you to provide to A.K. and her daughters? What early detection measures are important for them to know?
  10. Evidence-Based Practice: A.K. wants to know what the psychologic benefit may be for her daughters if they decide on a breast cancer genetic risk assessment.
  11. Patient-Centered Care: How will you include cultural preferences in A.K.'s plan of care?
  12. Teamwork and Collaboration: What types of referrals may be indicated for A.K.?
  13. Safety: Describe specific nursing interventions aimed at minimizing risk of harm for A.K.
  14. Quality Improvement: What outcomes would indicate nursing interventions were successful for A.K.
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Answer #1

#. A.K is very much worried with the disease because she has a family history of it and it's being genetically transferred from one to another women of the family . And because of which her coping response to disease is a bit cumbersome.

#. I would provide her information about the surgery ,how much part of the breast and surrounding would be removed ,how it would look , what all aftercare needs to be done , post surgery exercises to be done , infection prevention , about silicon breast available.

#. Complications after the surgery are :-

-skin flap necrosis

-hematoma

-infection

-lymphedema

#. Common postoperative exercises A.K. will need to practice after her surgery are :-

Begin each session by circling your shoulders to get the muscles moving. Other early exercises are :-

brushing or combing your hair

slowly reaching up behind your back to touch just under the shoulder blades

Once your drains and stitches are out, and as you get stronger and more confident you can do more of the exercises and increase the range of movements.

- pump it up

- arm lift

- shoulder blade squeeze

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